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1.
J Nutr ; 152(3): 737-746, 2022 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-34875094

RESUMO

BACKGROUND: Based on limited data, it is estimated that the placenta retains 90 mg of iron. Little is known about determinants of placental iron content. Animal data indicate that the placenta prioritizes iron for its own needs, but this hypothesis has not been evaluated in humans. OBJECTIVES: To characterize placental iron content and placental iron concentration (p[Fe]) in pregnant women at risk of iron insufficiency and identify determinants of p[Fe]. METHODS: Placentas were collected from 132 neonates born to teens carrying singletons (≤18 y) and 101 neonates born to 48 women carrying multiples (20-46 y). Maternal and neonatal iron status indicators [hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), serum iron, total body iron (TBI)] and hormones (erythropoietin, hepcidin) were measured. p[Fe] was measured using inductively coupled plasma-mass spectrometry. Correlation analyses and mixed-effects models were constructed to identify determinants of p[Fe]. RESULTS: Mean placental iron content was 23 mg per placenta (95% CI: 15, 33 mg) in the multiples and 40 mg (95% CI: 31, 51 mg) in the teens (P = 0.03). Mean p[Fe] did not differ between the cohorts. p[Fe] was higher in anemic (175 µg/g; 95% CI: 120, 254 µg/g) compared with nonanemic (46 µg/g; 95% CI: 26, 82 µg/g) women carrying multiples (P = 0.009), but did not differ between anemic (62 µg/g; 95% CI: 40, 102 µg/g) and nonanemic (73 µg/g; 95% CI: 56, 97 µg/g) teens. In women carrying multiples, low maternal iron status [lower SF (P = 0.002) and lower TBI (P = 0.01)] was associated with higher p[Fe], whereas in teens, improved iron status [lower sTfR (P = 0.03) and higher TBI (P = 0.03)] was associated with higher p[Fe]. CONCLUSIONS: Placental iron content was ∼50% lower than previously estimated. p[Fe] is significantly associated with maternal iron status. In women carrying multiples, poor maternal iron status was associated with higher p[Fe], whereas in teens, improved iron status was associated with higher p[Fe]. More data are needed to understand determinants of p[Fe] and the variable iron partitioning in teens compared with mature women.


Assuntos
Anemia Ferropriva , Anemia , Deficiências de Ferro , Adolescente , Feminino , Ferritinas , Hemoglobinas/metabolismo , Humanos , Ferro , Placenta/metabolismo , Gravidez , Receptores da Transferrina
2.
Sci Total Environ ; 780: 146555, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34030322

RESUMO

Extensive development of horizontal drilling and hydraulic fracturing enhanced energy production but raised concerns about drinking-water quality in areas of shale-gas development. One particularly controversial case that has received significant public and scientific attention involves possible contamination of groundwater in the Trinity Aquifer in Parker County, Texas. Despite extensive work, the origin of natural gas in the Trinity Aquifer within this study area is an ongoing debate. Here, we present a comprehensive geochemical dataset collected across three sampling campaigns along with integration of previously published data. Data include major and trace ions, molecular gas compositions, compound-specific stable isotopes of hydrocarbons (δ13C-CH4, δ13C-C2H6, δ2H-CH4), dissolved inorganic carbon (δ13C-DIC), nitrogen (δ15N-N2), water (δ18O, δ2H, 3H), and noble gases (He, Ne, Ar), boron (δ11B) and strontium (87Sr/86Sr) isotopic compositions of water samples from 20 drinking-water wells from the Trinity Aquifer. The compendium of data confirms mixing between a deep, naturally occurring salt- (Cl >250 mg/L) and hydrocarbon-rich groundwater with a low-salinity, shallower, and younger groundwater. Hydrocarbon gases display strong evidence for sulfate reduction-paired oxidation, in some cases followed by secondary methanogenesis. A subset of drinking-water wells contains elevated levels of hydrocarbons and depleted atmospherically-derived gas tracers, which is consistent with the introduction of fugitive thermogenic gas. We suggest that gas originating from the intermediate-depth Strawn Group ("Strawn") is flowing along the annulus of a Barnett Shale gas well, and is subsequently entering the shallow aquifer system. This interpretation is supported by the expansion in the number of affected drinking-water wells during our study period and the persistence of hydrocarbon levels over time. Our data suggest post-genetic secondary water quality changes occur following fugitive gas contamination, including sulfate reduction paired with hydrocarbon oxidation and secondary methanogenesis. Importantly, no evidence for upward migration of brine or natural gas associated with the Barnett Shale was identified.


Assuntos
Água Subterrânea , Poluentes Químicos da Água , Monitoramento Ambiental , Metano/análise , Gás Natural , Campos de Petróleo e Gás , Texas , Poluentes Químicos da Água/análise , Qualidade da Água , Poços de Água
3.
Environ Epigenet ; 5(3): dvz014, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31528362

RESUMO

Cadmium (Cd) is a ubiquitous environmental pollutant associated with a wide range of health outcomes including cancer. However, obscure exposure sources often hinder prevention efforts. Further, although epigenetic mechanisms are suspected to link these associations, gene sequence regions targeted by Cd are unclear. Aberrant methylation of a differentially methylated region (DMR) on the MEG3 gene that regulates the expression of a cluster of genes including MEG3, DLK1, MEG8, MEG9 and DIO3 has been associated with multiple cancers. In 287 infant-mother pairs, we used a combination of linear regression and the Getis-Ord Gi* statistic to determine if maternal blood Cd concentrations were associated with offspring CpG methylation of the sequence region regulating a cluster of imprinted genes including MEG3. Correlations were used to examine potential sources and routes. We observed a significant geographic co-clustering of elevated prenatal Cd levels and MEG3 DMR hypermethylation in cord blood (P = 0.01), and these findings were substantiated in our statistical models (ß = 1.70, se = 0.80, P = 0.03). These associations were strongest in those born to African American women (ß = 3.52, se = 1.32, P = 0.01) compared with those born to White women (ß = 1.24, se = 2.11, P = 0.56) or Hispanic women (ß = 1.18, se = 1.24, P = 0.34). Consistent with Cd bioaccumulation during the life course, blood Cd levels increased with age (ß = 0.015 µg/dl/year, P = 0.003), and Cd concentrations were significantly correlated between blood and urine (ρ > 0.47, P < 0.01), but not hand wipe, soil or house dust concentrations (P > 0.05). Together, these data support that prenatal Cd exposure is associated with aberrant methylation of the imprint regulatory element for the MEG3 gene cluster at birth. However, neither house-dust nor water are likely exposure sources, and ingestion via contaminated hands is also unlikely to be a significant exposure route in this population. Larger studies are required to identify routes and sources of exposure.

4.
Front Microbiol ; 9: 2646, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30498478

RESUMO

Hydraulic fracturing is the prevailing method for enhancing recovery of hydrocarbon resources from unconventional shale formations, yet little is understood regarding the microbial impact on biogeochemical cycling in natural-gas wells. Although the metabolisms of certain fermentative bacteria and methanogenic archaea that dominate in later produced fluids have been well studied, few details have been reported on microorganisms prevelant during the early flowback period, when oxygen and other surface-derived oxyanions and nutrients become depleted. Here, we report the isolation, genomic and phenotypic characterization of Marinobacter and Arcobacter bacterial species from natural-gas wells in the Utica-Point Pleasant and Marcellus Formations coupled to supporting geochemical and metagenomic analyses of produced fluid samples. These unconventional hydrocarbon system-derived Marinobacter sp. are capable of utilizing a diversity of organic carbon sources including aliphatic and aromatic hydrocarbons, amino acids, and carboxylic acids. Marinobacter and Arcobacter can metabolize organic nitrogen sources and have the capacity for denitrification and dissimilatory nitrate reduction to ammonia (DNRA) respectively; with DNRA and ammonification processes partially explaining high concentrations of ammonia measured in produced fluids. Arcobacter is capable of chemosynthetic sulfur oxidation, which could fuel metabolic processes for other heterotrophic, fermentative, or sulfate-reducing community members. Our analysis revealed mechanisms for growth of these taxa across a broad range of salinities (up to 15% salt), which explains their enrichment during early natural-gas production. These results demonstrate the prevalence of Marinobacter and Arcobacter during a key maturation phase of hydraulically fractured natural-gas wells, and highlight the significant role these genera play in biogeochemical cycling for this economically important energy system.

5.
Ground Water ; 56(2): 204-224, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29409148

RESUMO

Horizontal drilling and hydraulic fracturing have enhanced unconventional hydrocarbon recovery but raised environmental concerns related to water quality. Because most basins targeted for shale-gas development in the USA have histories of both active and legacy petroleum extraction, confusion about the hydrogeological context of naturally occurring methane in shallow aquifers overlying shales remains. The Karoo Basin, located in South Africa, provides a near-pristine setting to evaluate these processes, without a history of conventional or unconventional energy extraction. We conducted a comprehensive pre-industrial evaluation of water quality and gas geochemistry in 22 groundwater samples across the Karoo Basin, including dissolved ions, water isotopes, hydrocarbon molecular and isotopic composition, and noble gases. Methane-rich samples were associated with high-salinity, NaCl-type groundwater and elevated levels of ethane, 4 He, and other noble gases produced by radioactive decay. This endmember displayed less negative δ13 C-CH4 and evidence of mixing between thermogenic natural gases and hydrogenotrophic methane. Atmospheric noble gases in the methane-rich samples record a history of fractionation during gas-phase migration from source rocks to shallow aquifers. Conversely, methane-poor samples have a paucity of ethane and 4 He, near saturation levels of atmospheric noble gases, and more negative δ13 C-CH4 ; methane in these samples is biogenic and produced by a mixture of hydrogenotrophic and acetoclastic sources. These geochemical observations are consistent with other basins targeted for unconventional energy extraction in the USA and contribute to a growing data base of naturally occurring methane in shallow aquifers globally, which provide a framework for evaluating environmental concerns related to unconventional energy development (e.g., stray gas).


Assuntos
Água Subterrânea/química , Hidrocarbonetos/análise , Campos de Petróleo e Gás , Monitoramento Ambiental , Metano , Gás Natural , Poluentes Químicos da Água
6.
Ground Water ; 56(2): 163-175, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29361650

RESUMO

Horizontal drilling and hydraulic fracturing have enabled hydrocarbon recovery from unconventional reservoirs, but led to natural gas contamination of shallow groundwaters. We describe and apply numerical models of gas-phase migration associated with leaking natural gas wells. Three leakage scenarios are simulated: (1) high-pressure natural gas pulse released into a fractured aquifer; (2) continuous slow leakage into a tilted fractured formation; and (3) continuous slow leakage into an unfractured aquifer with fluvial channels, to facilitate a generalized evaluation of natural gas transport from faulty natural gas wells. High-pressure pulses of gas leakage into sparsely fractured media are needed to produce the extensive and rapid lateral spreading of free gas previously observed in field studies. Transport in fractures explains how methane can travel vastly different distances and directions laterally away from a leaking well, which leads to variable levels of methane contamination in nearby groundwater wells. Lower rates of methane leakage (≤1 Mcf/day) produce shorter length scales of gas transport than determined by the high-pressure scenario or field studies, unless aquifers have low vertical permeabilities (≤1 millidarcy) and fractures and bedding planes have sufficient tilt (∼10°) to allow a lateral buoyancy component. Similarly, in fractured rock aquifers or where permeability is controlled by channelized fluvial deposits, lateral flow is not sufficiently developed to explain fast-developing gas contamination (0-3 months) or large length scales (∼1 km) documented in field studies. Thus, current efforts to evaluate the frequency, mechanism, and impacts of natural gas leakage from faulty natural gas wells likely underestimate contributions from small-volume, low-pressure leakage events.


Assuntos
Água Subterrânea , Metano/análise , Gás Natural , Campos de Petróleo e Gás , Poluentes Químicos da Água
7.
Proc Natl Acad Sci U S A ; 113(48): 13636-13641, 2016 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-27849603

RESUMO

Recent measurements of methane emissions from abandoned oil/gas wells show that these wells can be a substantial source of methane to the atmosphere, particularly from a small proportion of high-emitting wells. However, identifying high emitters remains a challenge. We couple 163 well measurements of methane flow rates; ethane, propane, and n-butane concentrations; isotopes of methane; and noble gas concentrations from 88 wells in Pennsylvania with synthesized data from historical documents, field investigations, and state databases. Using our databases, we (i) improve estimates of the number of abandoned wells in Pennsylvania; (ii) characterize key attributes that accompany high emitters, including depth, type, plugging status, and coal area designation; and (iii) estimate attribute-specific and overall methane emissions from abandoned wells. High emitters are best predicted as unplugged gas wells and plugged/vented gas wells in coal areas and appear to be unrelated to the presence of underground natural gas storage areas or unconventional oil/gas production. Repeat measurements over 2 years show that flow rates of high emitters are sustained through time. Our attribute-based methane emission data and our comprehensive estimate of 470,000-750,000 abandoned wells in Pennsylvania result in estimated state-wide emissions of 0.04-0.07 Mt (1012 g) CH4 per year. This estimate represents 5-8% of annual anthropogenic methane emissions in Pennsylvania. Our methodology combining new field measurements with data mining of previously unavailable well attributes and numbers of wells can be used to improve methane emission estimates and prioritize cost-effective mitigation strategies for Pennsylvania and beyond.

8.
Environ Sci Technol ; 50(19): 10504-10511, 2016 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-27632066

RESUMO

Methane emissions from streams and rivers have recently been recognized as an important component of global greenhouse budgets. Stream methane is lost as evasion to the atmosphere or in-stream methane oxidation. Previous studies have quantified evasion and oxidation with point-scale measurements. In this study, dissolved gases (methane, krypton) were injected into a coastal plain stream in North Carolina to quantify stream CH4 losses at the watershed scale. Stream-reach modeling yielded gas transfer and oxidation rate constants of 3.2 ± 0.5 and 0.5 ± 1.5 d-1, respectively, indicating a ratio of about 6:1. The resulting evasion and oxidation rates of 2.9 mmol m-2 d-1 and 1,140 nmol L-1 d-1, respectively, lie within ranges of published values. Similarly, the gas transfer velocity (K600) of 2.1 m d-1 is consistent with other gas tracer studies. This study illustrates the utility of dissolved-gas tracers for evaluating stream methane fluxes. In contrast to point measurements, this approach provides a larger watershed-scale perspective. Further work is needed to quantify the magnitude of these fluxes under varying conditions (e.g., stream temperature, nutrient load, gradient, flow rate) at regional and global scales before reliable bottom-up estimates of methane evasion can be determined at global scales.


Assuntos
Metano , Rios , Atmosfera , Gases , North Carolina
9.
Proc Natl Acad Sci U S A ; 112(43): 13184-9, 2015 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-26460018

RESUMO

Hundreds of organic chemicals are used during natural gas extraction via high-volume hydraulic fracturing (HVHF). However, it is unclear whether these chemicals, injected into deep shale horizons, reach shallow groundwater aquifers and affect local water quality, either from those deep HVHF injection sites or from the surface or shallow subsurface. Here, we report detectable levels of organic compounds in shallow groundwater samples from private residential wells overlying the Marcellus Shale in northeastern Pennsylvania. Analyses of purgeable and extractable organic compounds from 64 groundwater samples revealed trace levels of volatile organic compounds, well below the Environmental Protection Agency's maximum contaminant levels, and low levels of both gasoline range (0-8 ppb) and diesel range organic compounds (DRO; 0-157 ppb). A compound-specific analysis revealed the presence of bis(2-ethylhexyl) phthalate, which is a disclosed HVHF additive, that was notably absent in a representative geogenic water sample and field blanks. Pairing these analyses with (i) inorganic chemical fingerprinting of deep saline groundwater, (ii) characteristic noble gas isotopes, and (iii) spatial relationships between active shale gas extraction wells and wells with disclosed environmental health and safety violations, we differentiate between a chemical signature associated with naturally occurring saline groundwater and one associated with alternative anthropogenic routes from the surface (e.g., accidental spills or leaks). The data support a transport mechanism of DRO to groundwater via accidental release of fracturing fluid chemicals derived from the surface rather than subsurface flow of these fluids from the underlying shale formation.


Assuntos
Gasolina/análise , Água Subterrânea/química , Indústria de Petróleo e Gás , Compostos Orgânicos/análise , Poluentes Químicos da Água/análise , Cromatografia Gasosa-Espectrometria de Massas
11.
Proc Natl Acad Sci U S A ; 111(39): 14076-81, 2014 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-25225410

RESUMO

Horizontal drilling and hydraulic fracturing have enhanced energy production but raised concerns about drinking-water contamination and other environmental impacts. Identifying the sources and mechanisms of contamination can help improve the environmental and economic sustainability of shale-gas extraction. We analyzed 113 and 20 samples from drinking-water wells overlying the Marcellus and Barnett Shales, respectively, examining hydrocarbon abundance and isotopic compositions (e.g., C2H6/CH4, δ(13)C-CH4) and providing, to our knowledge, the first comprehensive analyses of noble gases and their isotopes (e.g., (4)He, (20)Ne, (36)Ar) in groundwater near shale-gas wells. We addressed two questions. (i) Are elevated levels of hydrocarbon gases in drinking-water aquifers near gas wells natural or anthropogenic? (ii) If fugitive gas contamination exists, what mechanisms cause it? Against a backdrop of naturally occurring salt- and gas-rich groundwater, we identified eight discrete clusters of fugitive gas contamination, seven in Pennsylvania and one in Texas that showed increased contamination through time. Where fugitive gas contamination occurred, the relative proportions of thermogenic hydrocarbon gas (e.g., CH4, (4)He) were significantly higher (P < 0.01) and the proportions of atmospheric gases (air-saturated water; e.g., N2, (36)Ar) were significantly lower (P < 0.01) relative to background groundwater. Noble gas isotope and hydrocarbon data link four contamination clusters to gas leakage from intermediate-depth strata through failures of annulus cement, three to target production gases that seem to implicate faulty production casings, and one to an underground gas well failure. Noble gas data appear to rule out gas contamination by upward migration from depth through overlying geological strata triggered by horizontal drilling or hydraulic fracturing.


Assuntos
Gases Nobres/análise , Campos de Petróleo e Gás , Poluentes Químicos da Água/análise , Abastecimento de Água/análise , Poços de Água/análise , Meio Ambiente , Monitoramento Ambiental , Água Subterrânea , Humanos , Modelos Teóricos , Pennsylvania , Texas , Poluição Química da Água
12.
Environ Geochem Health ; 36(4): 797-814, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24844320

RESUMO

There is an increasing public awareness of the relatively new and expanded industrial barium uses which are potential sources of human exposure (e.g., a shale gas development that causes an increased awareness of environmental exposures to barium). However, absorption of barium in exposed humans and a full spectrum of its health effects, especially among chronically exposed to moderate and low doses of barium populations, remain unclear. We suggest a systematic literature review (from 1875 to 2014) on environmental distribution of barium, its bioaccumulation, and potential and proven health impacts (in animal models and humans) to provide the information that can be used for optimization of future experimental and epidemiological studies and developing of mitigative and preventive strategies to minimize negative health effects in exposed populations. The potential health effects of barium exposure are largely based on animal studies, while epidemiological data for humans, specifically for chronic low-level exposures, are sparse. The reported health effects include cardiovascular and kidney diseases, metabolic, neurological, and mental disorders. Age, race, dietary patterns, behavioral risks (e.g., smoking), use of medications (those that interfere with absorbed barium in human organism), and specific physiological status (e.g., pregnancy) can modify barium effects on human health. Identifying, evaluating, and predicting the health effects of chronic low-level and moderate-level barium exposures in humans is challenging: Future research is needed to develop an understanding of barium bioaccumulation in order to mitigate its potential health impacts in various exposured populations. Further, while occupationally exposed at-risk populations exist, it is also important to identify potentially vulnerable subgroups among non-occupationally exposed populations (e.g., elderly, pregnant women, children) who are at higher risk of barium exposure from drinking water and food.


Assuntos
Bário/análise , Bário/toxicidade , Exposição Ambiental/efeitos adversos , Administração Oral , Animais , Bário/farmacocinética , Água Potável , Exposição Ambiental/análise , Humanos , Indústrias , Medição de Risco
13.
Environ Sci Technol ; 48(15): 8334-48, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24606408

RESUMO

The rapid rise of shale gas development through horizontal drilling and high volume hydraulic fracturing has expanded the extraction of hydrocarbon resources in the U.S. The rise of shale gas development has triggered an intense public debate regarding the potential environmental and human health effects from hydraulic fracturing. This paper provides a critical review of the potential risks that shale gas operations pose to water resources, with an emphasis on case studies mostly from the U.S. Four potential risks for water resources are identified: (1) the contamination of shallow aquifers with fugitive hydrocarbon gases (i.e., stray gas contamination), which can also potentially lead to the salinization of shallow groundwater through leaking natural gas wells and subsurface flow; (2) the contamination of surface water and shallow groundwater from spills, leaks, and/or the disposal of inadequately treated shale gas wastewater; (3) the accumulation of toxic and radioactive elements in soil or stream sediments near disposal or spill sites; and (4) the overextraction of water resources for high-volume hydraulic fracturing that could induce water shortages or conflicts with other water users, particularly in water-scarce areas. Analysis of published data (through January 2014) reveals evidence for stray gas contamination, surface water impacts in areas of intensive shale gas development, and the accumulation of radium isotopes in some disposal and spill sites. The direct contamination of shallow groundwater from hydraulic fracturing fluids and deep formation waters by hydraulic fracturing itself, however, remains controversial.


Assuntos
Indústrias Extrativas e de Processamento , Gás Natural , Recursos Hídricos , Meio Ambiente , Água Doce , Água Subterrânea , Humanos , Risco , Estados Unidos , Águas Residuárias , Poluição da Água
14.
Proc Natl Acad Sci U S A ; 110(28): 11250-5, 2013 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-23798404

RESUMO

Horizontal drilling and hydraulic fracturing are transforming energy production, but their potential environmental effects remain controversial. We analyzed 141 drinking water wells across the Appalachian Plateaus physiographic province of northeastern Pennsylvania, examining natural gas concentrations and isotopic signatures with proximity to shale gas wells. Methane was detected in 82% of drinking water samples, with average concentrations six times higher for homes <1 km from natural gas wells (P = 0.0006). Ethane was 23 times higher in homes <1 km from gas wells (P = 0.0013); propane was detected in 10 water wells, all within approximately 1 km distance (P = 0.01). Of three factors previously proposed to influence gas concentrations in shallow groundwater (distances to gas wells, valley bottoms, and the Appalachian Structural Front, a proxy for tectonic deformation), distance to gas wells was highly significant for methane concentrations (P = 0.007; multiple regression), whereas distances to valley bottoms and the Appalachian Structural Front were not significant (P = 0.27 and P = 0.11, respectively). Distance to gas wells was also the most significant factor for Pearson and Spearman correlation analyses (P < 0.01). For ethane concentrations, distance to gas wells was the only statistically significant factor (P < 0.005). Isotopic signatures (δ(13)C-CH4, δ(13)C-C2H6, and δ(2)H-CH4), hydrocarbon ratios (methane to ethane and propane), and the ratio of the noble gas (4)He to CH4 in groundwater were characteristic of a thermally postmature Marcellus-like source in some cases. Overall, our data suggest that some homeowners living <1 km from gas wells have drinking water contaminated with stray gases.

15.
J Clin Oncol ; 30(3): 300-7, 2012 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-22184390

RESUMO

PURPOSE: Cisplatin-induced neurotoxicity and ototoxicity (NTX) are important adverse effects after chemotherapy for testicular cancer (TC). Although serum platinum is measurable years after therapy, its impact on NTX has not been evaluated. PATIENTS AND METHODS: In all, 169 cisplatin-treated survivors of TC provided blood samples at Survey I and reported NTX during Survey I (1998-2002) and Survey II (2007-2008). Serum platinum was quantified by inductively coupled plasma mass spectrometry. Patient-reported outcomes were evaluated with the Scale for Chemotherapy-Induced Neurotoxicity (SCIN), regarding the extent of symptom bother as 0, "not at all"; 1, "a little"; 2, "quite a bit"; or 3, "very much." Summing the six symptom scores yielded a total SCIN score of 0 to 18. Categorizing total SCIN scores into quartiles yielded similar-sized groups with increasing symptoms. Multivariate ordinal logistic regression analyses evaluated associations between NTX and long-term serum platinum levels, adjusting for cisplatin dose, dosing schedule, and age. RESULTS: At Survey I, a significant four- to five-fold association with total SCIN score emerged for the highest serum platinum quartile (odds ratio [OR], 4.69; 95% CI, 1.82 to 12.08). Paresthesias and Raynaud's syndrome (hands and feet) showed significant two- to four-fold increased risks with the highest platinum quartile. At Survey II, total SCIN score remained significantly associated with the highest platinum quartile (OR, 4.28; 95% CI, 1.36 to 13.48). Paresthesias (hands and feet) and tinnitus showed significant three- to four-fold increased risks for the highest platinum quartile. Cumulative cisplatin dose was not associated with total SCIN score or individual SCIN symptoms in multivariate analyses. CONCLUSION: Here we document a significant relationship between increasing levels of residual serum platinum and NTX severity after adjusting for initial cisplatin dose.


Assuntos
Cisplatino/administração & dosagem , Cóclea/efeitos dos fármacos , Síndromes Neurotóxicas/sangue , Platina/sangue , Neoplasias Testiculares/sangue , Membrana Timpânica/efeitos dos fármacos , Adolescente , Adulto , Cisplatino/efeitos adversos , Cisplatino/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Neurotóxicas/etiologia , Inquéritos e Questionários , Análise de Sobrevida , Sobreviventes , Neoplasias Testiculares/tratamento farmacológico , Adulto Jovem
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